Provider Demographics
NPI:1518098771
Name:COMMUNITY YOUTH NETWORK, INC
Entity Type:Organization
Organization Name:COMMUNITY YOUTH NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDLOW
Authorized Official - Suffix:
Authorized Official - Credentials:CBCS
Authorized Official - Phone:847-548-6000
Mailing Address - Street 1:18640 W IL ROUTE 120
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030
Mailing Address - Country:US
Mailing Address - Phone:847-548-6000
Mailing Address - Fax:847-548-6040
Practice Address - Street 1:18640 W IL ROUTE 120
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030
Practice Address - Country:US
Practice Address - Phone:847-548-6000
Practice Address - Fax:847-548-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL149001053104100000X
IL5138-995-6251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty